| 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 |