| NPI | 1861070542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: PA MT223468) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT223468) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2024-05-30 |