| NPI | 1811218654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036151382) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 40881) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2020-04-27 |