| NPI | 1780261768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology (Licence: FL 167067) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 13436) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2024-05-15 |