| NPI | 1922591957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18004136A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901005108) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2020-09-28 |