| NPI | 1225698814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA A193042) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME10525) |
| 208D00000X General Practice (Licence: FL ME160525) | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-03-12 |