| NPI | 1922349836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1806) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003767A) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2019-04-04 |