| NPI | 1013296730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 273207) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NC 2018-01919) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: RI MD 14898) | |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2023-03-07 |