| NPI | 1497049175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: AZ 49618) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2017-06-14 |