| NPI | 1881757177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003489A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901003625) |
| 152WS0006X Optometrist, Sports Vision (Licence: IN 18003489A) | |
| 152WP0200X Optometrist, Pediatrics (Licence: IN 18003489A) | |
| 152WP0200X Optometrist, Pediatrics (Licence: IN 18003489B) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2014-11-04 |