| NPI | 1972563021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD650) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD0000000650) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2016-05-31 |