| NPI | 1164834735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 67233) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.064656) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2020-07-28 |