| NPI | 1164775912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G172994) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 23959) |
| 208000000X Pediatrics (Licence: IL 036.130885) | |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2021-11-30 |