| NPI | 1104845023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: NY 149916) |
| Additional Taxonomies | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: FL ME68998) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-10-12 |