| NPI | 1144585282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036170487) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301100321) |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2025-09-30 |