| NPI | 1639737992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207WX0110X Ophthalmology Pediatric Ophthalmology and Strabismus Specialist (Licence: FL ME148271) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME148271) |
| Enumeration Date | 2019-06-02 |
| Last Update Date | 2022-06-15 |