| NPI | 1760656227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 57474) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.012843) |
| 208000000X Pediatrics (Licence: WI 57474) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2013-07-03 |