| NPI | 1740293091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 74401) |
| Additional Taxonomies | 2080P1004X Pediatrics, Physician Nutrition Specialist (Licence: MA 1010063R) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2025-07-09 |