| NPI | 1669964334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: UT 13867707-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R77002) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2024-06-21 |