| NPI | 1437696663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036.152741) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.070164) |
| 385H00000X Respite Care | |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2020-06-19 |