| NPI | 1942795349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 81218) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036160745) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2025-09-30 |