| NPI | 1952544918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036.140474) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 053520) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2022-02-07 |