| NPI | 1851684542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: FL ME129261) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 15898) |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2022-07-21 |