| NPI | 1952452682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD0000000975) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 975) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-10-17 |