| NPI | 1114136934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CA C183143) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: KY TP774) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: OH 35085878) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2022-12-20 |