| NPI | 1316133218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: TX N4046) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N4046) |
| 208000000X Pediatrics (Licence: NM MD 2009-0066) | |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2026-05-01 |