| NPI | 1093766875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NJ mb072525) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: DE c2-0007817) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2013-05-21 |