| NPI | 1013255090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60913780) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WA MD60913780) |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2020-08-04 |