| NPI | 1104835727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 46376) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 36-102407) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-04-26 |