| NPI | 1114486115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME168009) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036160247) |
| 208000000X Pediatrics (Licence: MO 2022004027) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-08-14 |