| NPI | 1700810454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: ID M11332) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 228002) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: WA MD0004285) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-07-30 |