| NPI | 1013994730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: SD 5852) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 47322) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-04-04 |