| NPI | 1942562590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A158276) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125-060966) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2022-11-09 |