| NPI | 1417397472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: WV 30353) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2013022089) |
| Enumeration Date | 2013-07-04 |
| Last Update Date | 2022-04-06 |