| NPI | 1033630785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.150240) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-172098) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2024-10-03 |