| NPI | 1497109425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: FL ME162308) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME162308) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: OH 35.136446) | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2024-05-23 |