| NPI | 1659381853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: WV 28403) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX K8856) |
| 208000000X Pediatrics (Licence: TX K8856) | |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: TX K8856) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-12-20 |