| NPI | 1508973603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 45299) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-102772) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2019-02-21 |