| NPI | 1194930198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: FL ME117408) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME117408) |
| 208000000X Pediatrics (Licence: MI 4301086030) | |
| 208000000X Pediatrics (Licence: SD 7325) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN18047) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2019-07-02 |