| NPI | 1083052955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME147729) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101256982) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2023-07-21 |