| NPI | 1578115622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2022-01098) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 0000000000000000000) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NC 000000000) | |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2022-05-06 |