| NPI | 1679545560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: WV 24418) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: AZ 55691) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2019-09-16 |