| NPI | 1104188713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: VA 0101255454) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101255454) |
| Enumeration Date | 2012-06-10 |
| Last Update Date | 2020-08-04 |