| NPI | 1710024278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: PR 9135) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 9135) |
| 208000000X Pediatrics (Licence: PR 9135) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2015-09-11 |