| NPI | 1265485767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: MA 156574) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MA 156574) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-06-05 |