| NPI | 1588000301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CT 62556) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 266637) |
| 208000000X Pediatrics (Licence: PA MT204209) | |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 266637) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2022-04-25 |