| NPI | 1588928089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: PA MT212070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-061922) |
| 208000000X Pediatrics (Licence: IL 125-061922) | |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2017-05-08 |