| NPI | 1952510992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: PA MD440048) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301084494) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: RI MD12734) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-03-08 |