| NPI | 1902049851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MI 4301103434) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301103434) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 11484) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2013-09-03 |