| NPI | 1093866972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: FL ME97762) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME97762) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-08-28 |