| NPI | 1033358858 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: OH 35.123656)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.123656)  | 
| Enumeration Date | 2009-02-18 | 
| Last Update Date | 2024-07-23 |