| NPI | 1659560712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: WI 51914) |
| Additional Taxonomies | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: IN 39020000X) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2011-08-22 |