| NPI | 1245506328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036137562) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101282817) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2024-09-03 |