| NPI | 1770729188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: PA MD443200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD443200) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2018-11-19 |