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 |