| NPI | 1104117399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60450630) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WA MD60450630) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2021-03-29 |