| NPI | 1932153830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MN 56005) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: WI 44446) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MN 106399) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2020-08-20 |