| NPI | 1609371822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME154852) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA A186632) |
| 208D00000X General Practice (Licence: FL ME154852) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2023-08-09 |