| NPI | 1811940497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036136683) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35085802) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-05-18 |