| NPI | 1861829012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60637675) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125063929) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2018-04-12 |