| NPI | 1982685244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: GA 035801) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: AL 00020756) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2008-03-04 |