| NPI | 1235640871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ME OPT1060) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME PR46880) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2022-12-28 |