NPI | 1629411855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: NC 2019-00398) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2013-04-08 |
Last Update Date | 2021-04-13 |