| NPI | 1942862065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: MI 4301505040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351045611) |
| 208000000X Pediatrics (Licence: MI 4351045611) | |
| Enumeration Date | 2019-06-29 |
| Last Update Date | 2026-08-31 |