| NPI | 1770843716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: PA MT211479) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP02451) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: RI LP02451) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: RI LP02451) | |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2020-09-29 |