| NPI | 1467087403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301511096) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.077674) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2026-07-13 |