| NPI | 1265747596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MO 2015030336) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2015030336) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2025-05-21 |