| NPI | 1104984707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WA MD00047942) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-08-0778) |
| 207R00000X Internal Medicine (Licence: OH 35-08-0778) | |
| 207R00000X Internal Medicine (Licence: WA MD00047942) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2021-06-25 |