| NPI | 1508271255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036143166) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125-0645453) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2017-05-13 |