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 |