| NPI | 1154881282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036.163453) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL OS18552) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036.163453) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2023-07-04 |