| NPI | 1508811688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MO R3A82) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: KS 04-19862) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2007-07-08 |