| NPI | 1689737660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist Pediatrics (Licence: MD P52902) |
| Additional Taxonomies | 2080P0207X Pediatrics Pediatric Hematology-Oncology (Licence: MD D52902) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |