| NPI | 1932605813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: WA OL61414717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018375) |
| 208000000X Pediatrics (Licence: PA OS022064) | |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2023-07-03 |