NPI | 1700868981 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: FL ME120291) |
Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: IA 35973) |
Enumeration Date | 2005-11-15 |
Last Update Date | 2014-07-18 |