| NPI | 1740509371 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MN 58606) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.132249) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2014-12-09 |