| NPI | 1669472866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M5099) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036101093) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2017-01-30 |