| NPI | 1992282529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3691) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 975) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2021-07-26 |