| NPI | 1487945135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: UT 10316335-1205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: ID M-13995) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2021-12-17 |