| NPI | 1982617528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MN 48958) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: IA 38222) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MN 102452) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-18 |