| NPI | 1275685596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WA MD60737701) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60737701) |
| 225100000X Physical Therapist (Licence: WA PT00010168) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2019-01-29 |