| NPI | 1457444945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.095160) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036109880) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2018-02-21 |