| NPI | 1639617897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036166380) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.078462) |
| 247200000X Technician, Other | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2024-05-07 |