NPI | 1124142500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: OH 89490) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301083864) |
2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MI 4301083864) | |
Enumeration Date | 2007-03-19 |
Last Update Date | 2023-06-16 |