| NPI | 1124265004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: PA OS013980) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: AZ 005201) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: ME DO2327) | |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2015-11-11 |