NPI | 1720475940 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MN 65202) |
Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.128852) |
Enumeration Date | 2015-04-26 |
Last Update Date | 2020-08-05 |