| NPI | 1023274610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 125.054085) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.126316) |
| Enumeration Date | 2008-08-02 |
| Last Update Date | 2010-12-13 |