| NPI | 1457766123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NC 2020-00462) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.130111) |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2024-02-20 |