| NPI | 1386023596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61064406) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: AK 122746) |
| 207Q00000X Family Medicine (Licence: AK 100985) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2021-05-10 |