| NPI | 1235124322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G17825) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G17825) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2007-11-28 |