| NPI | 1972529428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2654) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1682DT) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2017-12-14 |