| NPI | 1912928516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003718) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901004373) |
| 152W00000X Optometrist (Licence: SC 1510) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2014-12-01 |