| NPI | 1255918793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036166238) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.078224) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2024-06-04 |