| NPI | 1699153783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NJ 25MA11138500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA11138500) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2024-04-09 |