| NPI | 1982694147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: DE C10008372) |
| Additional Taxonomies | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: MA 220677) |
| 208000000X Pediatrics (Licence: MA 220677) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2008-09-03 |