| NPI | 1699801928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0035007) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME0035007) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2007-07-08 |