| NPI | 1477955540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: FL ME126384) |
| Additional Taxonomies | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: VA 0101254607) |
| Enumeration Date | 2014-09-20 |
| Last Update Date | 2016-11-16 |