| NPI | 1699271460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T1019) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-160685) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2023-11-08 |