| NPI | 1922082460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: KY 27381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 27381) |
| 208000000X Pediatrics (Licence: KY 27381) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2020-03-16 |