| NPI | 1699965988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: OH 35.123310) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML20008895) |
| 208000000X Pediatrics (Licence: MA 253645) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2014-05-07 |