| 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 |