| NPI | 1659365245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 21720-875) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-114318) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2022-02-09 |