| NPI | 1942409909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME120682) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2015-02-04 |