| NPI | 1679578363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME080121) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: GA ME050710) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2022-05-31 |