| NPI | 1932162849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME150541) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101238762) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2021-07-15 |