NPI | 1669463550 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 57051) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MA 57051) |
Enumeration Date | 2005-10-31 |
Last Update Date | 2012-08-01 |