| NPI | 1922678002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-328) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003481) |
| 152W00000X Optometrist (Licence: IN 18004262A) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2023-03-06 |