| NPI | 1861574212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD33171) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: DC MD33171) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2008-10-29 |