| NPI | 1023142395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NJ 25MA08533500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 234630) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2021-07-19 |