| NPI | 1225028301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 217506) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 217506) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2010-04-07 |