NPI | 1245494152 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MN 51832) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY not licensed yet) |
Enumeration Date | 2008-07-10 |
Last Update Date | 2020-08-11 |