| NPI | 1972967826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: OR MD211114) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD211114) |
| 208000000X Pediatrics (Licence: WA MD61304330) | |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: WA MD61304330) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2022-08-19 |