| NPI | 1376084707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301511122) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.152249) |
| Enumeration Date | 2017-03-18 |
| Last Update Date | 2024-04-01 |