NPI | 1063672038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: UT 9386804-1205) |
Additional Taxonomies | 208000000X Pediatrics (Licence: UT 9386804-1205) |
208000000X Pediatrics (Licence: MA 247128) | |
Enumeration Date | 2008-06-13 |
Last Update Date | 2025-09-19 |