| NPI | 1073883765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A12117) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61002767) |
| 207Q00000X Family Medicine (Licence: OR DO196273) | |
| 208M00000X Hospitalist (Licence: OR DO196273) | |
| 208M00000X Hospitalist (Licence: WA OP61002767) | |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2022-03-01 |