NPI | 1063943876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: TX S5506) |
Additional Taxonomies | 208000000X Pediatrics (Licence: TX S5506) |
208000000X Pediatrics (Licence: MO 2020020735) | |
Enumeration Date | 2017-03-23 |
Last Update Date | 2023-07-19 |