| NPI | 1376683003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036128431) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 42607) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-05-10 |