| NPI | 1235161712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: WA MD00035982) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA md00035982) |
| 208000000X Pediatrics (Licence: WA MD00035982) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-08-29 |