| NPI | 1194139337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: SC 84088) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301105294) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CA A148950) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2020-09-15 |