| NPI | 1689830465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 55689) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125-053967) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2014-10-08 |