| NPI | 1033372073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME 105283) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX M9848) |
| 207W00000X Ophthalmology (Licence: NY 249662) | |
| 207W00000X Ophthalmology (Licence: GA 062187) | |
| 208000000X Pediatrics (Licence: TX M9848) | |
| 208000000X Pediatrics (Licence: NY 249662) | |
| 208000000X Pediatrics (Licence: GA 062187) | |
| 208000000X Pediatrics (Licence: FL ME 105283) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2011-02-11 |