| NPI | 1912016783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: IL 036-093057) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036093057) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: IL 036093057) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-12-17 |