| NPI | 1164486585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME0049799) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0049799) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2019-02-19 |