| NPI | 1063275477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL ME166458) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME166458) |
| 207W00000X Ophthalmology (Licence: FL ME166458) | |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2024-01-31 |