| NPI | 1003234691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A17739) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 1003234691) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2020-08-17 |