| NPI | 1679860316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MI 4301099168) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301099168) |
| 208000000X Pediatrics (Licence: MI 4301099168) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2022-07-21 |