| NPI | 1992878144 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME65902) | 
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME65902) | 
| Enumeration Date | 2006-11-16 | 
| Last Update Date | 2025-01-28 |