| NPI | 1154882694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 292195) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 67756) |
| 208000000X Pediatrics (Licence: MN 30041) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2022-11-04 |