| NPI | 1962896316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 70097) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125067148) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2021-11-23 |