| NPI | 1952415689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003496A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001633) |
| 152W00000X Optometrist (Licence: KY 1679DT) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2013-03-21 |