NPI | 1194475269 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CA A201230) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2022-03-24 |
Last Update Date | 2025-06-13 |