| NPI | 1982629069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: TX M5468) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: LA MD.14871R) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2008-03-06 |