| NPI | 1104072172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 56404) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125-052976) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2013-06-04 |