| NPI | 1477111052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 77084) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125074255) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2022-07-11 |