| NPI | 1942756143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: CA A169322) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A169322) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2026-09-01 |