| NPI | 1407388648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: IL 036.152951) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2021-02-03 |