| NPI | 1750548848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CT 66386) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 1.066386) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: PA MD460608) | |
| Enumeration Date | 2008-05-18 |
| Last Update Date | 2020-09-18 |