| NPI | 1285241307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036.163065) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 190806) |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2023-10-16 |