| NPI | 1679950570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: SC 86455) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 56409) |
| 208000000X Pediatrics (Licence: TN 56409) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2021-08-17 |