| NPI | 1548243777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NY 240060) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 043418) |
| 208000000X Pediatrics (Licence: NY 240060) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2013-03-26 |