| NPI | 1679521421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0058398) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: FL ME0058398) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-07-01 |