| NPI | 1952747420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 282535) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 270786) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 270786) | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2020-06-18 |