| NPI | 1548751332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 319358) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.156556) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2022-10-12 |