| NPI | 1386657948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CA G61054) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G61054) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2026-07-15 |