| NPI | 1669404232 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: LA MD.203490) | 
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: AL 24193) | 
| Enumeration Date | 2006-07-06 | 
| Last Update Date | 2010-04-14 |