| NPI | 1083667646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C134912) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-068065) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2021-01-14 |