| NPI | 1578023727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 125.074934) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 324545) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2023-07-05 |