| NPI | 1093080749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CT 54272) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 241245) |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2022-04-15 |