| NPI | 1235395872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: NY 274258) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT192372) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2022-07-21 |