| NPI | 1437530128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.137537) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.067496) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2020-06-18 |