| NPI | 1003808114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 46329) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.147862) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2019-06-19 |