| NPI | 1760915482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: RI MD21304) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 1027207) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 31131) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2026-05-13 |