| NPI | 1912962168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MA 220952) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 220952) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: TX M5159) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2023-03-08 |