| NPI | 1942801907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: TN 3656) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3656) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2021-03-26 |