| NPI | 1952377723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: AZ 55425) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: IL 36105295) |
| 208D00000X General Practice (Licence: AZ 55425) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2021-08-19 |