| NPI | 1992200935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 89108) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.165651) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2023-12-12 |