| NPI | 1093780215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME0073913) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: FL ME0073913) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2023-06-02 |