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 |