| NPI | 1942243555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 238558) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.117924) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2008-08-15 |