| NPI | 1730745720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: WA MD.MD.61691769) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4351044321) |
| 208000000X Pediatrics (Licence: MI 4301506725) | |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2025-08-12 |