| NPI | 1013250745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: OH 34.015042) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN DO0000003005) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NC 225639) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2021-06-09 |