| NPI | 1912992439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 1800-2445B) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: IN 1800-2445AB) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2014-06-23 |