| NPI | 1952485146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: HI 5279) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: HI 5279) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2011-01-27 |