| NPI | 1063493914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CT 64286) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 64286) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2019-09-30 |