| NPI | 1629232582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D77723) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MD D77723) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2025-09-22 |