| NPI | 1962534206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: FL 84348) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0073675) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2012-06-15 |