| NPI | 1376620112 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: IL 036131328) | 
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NY 239052) | 
| 208000000X Pediatrics (Licence: IL 036131328) | |
| Enumeration Date | 2006-11-01 | 
| Last Update Date | 2025-10-30 |