| NPI | 1932156858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN TOD1237) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 5541646) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2008-06-02 |