| NPI | 1659537850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 125055456) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 80037461205) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2022-07-18 |