| NPI | 1700828464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: FL ME167918) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: GA 052907) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: OH 35-078856) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2024-07-02 |