| NPI | 1225066764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA G192049) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 189757) |
| 208000000X Pediatrics (Licence: IL 036143027) | |
| 208000000X Pediatrics (Licence: CA G192049) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: IL 036143027) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 189757) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2024-04-10 |