| NPI | 1093757585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME14464) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME14464) |
| 208600000X Surgery (Licence: FL ME14464) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2020-12-01 |