| 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 |