| NPI | 1073603635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: KY 48499) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: AR E-3061) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2016-02-05 |