| NPI | 1255436242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CA C142553) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C142553) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: KS 0430550) | |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MD D0071581) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2024-04-10 |