| NPI | 1851396964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: UT 82-168364-1205) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: UT 168364-1205) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2019-03-21 |