| NPI | 1871987800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 292354) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 37483) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2022-05-17 |