| NPI | 1831466796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: VA 0101268263) |
| Additional Taxonomies | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: OH 57.024051) |
| 208000000X Pediatrics (Licence: MI 4301098413) | |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2020-03-19 |