| NPI | 1801356910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME159044) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: FL ME159044) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2023-12-04 |