| NPI | 1790717312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: ME 015427) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ME 015427) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2011-01-10 |