| NPI | 1356571731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A119747) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125057064) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2013-05-23 |