| NPI | 1033791397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: NE 10009) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22424) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-06-25 |