| NPI | 1801028451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 250927) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 240745) |
| Enumeration Date | 2009-08-16 |
| Last Update Date | 2015-05-06 |