| 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 |