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 |