| NPI | 1710009287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 220873) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 231870) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-13 |