| NPI | 1295749729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60977071) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10004758) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-04-29 |