| NPI | 1639138852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CA A69432) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A69432) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2024-04-10 |