| NPI | 1306289285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: OH 35.132190) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.132190) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2020-07-08 |