| NPI | 1598175127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: FL ME153816) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD452325) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2024-04-03 |