| NPI | 1639630114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A176705) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125073610) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-06-20 |