| NPI | 1053623108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NY 269648) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT197087) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2021-12-09 |