| NPI | 1972856870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MD H83273) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 250382) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: TX P6227) | |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2019-05-22 |