| NPI | 1912490665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18004106A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 1800) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2022-04-04 |