| NPI | 1952409583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18001807B) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-0006940) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-08-15 |