| NPI | 1033156815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60138619) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-107237) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2011-03-30 |