| NPI | 1255379376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: MI 4301082689) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301082689) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2017-01-17 |