| NPI | 1104872175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WA MD00048751) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD26639) |
| 207Q00000X Family Medicine (Licence: WA MD00048751) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2011-04-19 |