| NPI | 1902467111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036.178711) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.146206) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2026-04-28 |