| NPI | 1639800022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OT022077) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.081243) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2023-06-23 |