| NPI | 1528175239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00043484) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD179056) |
| 208000000X Pediatrics (Licence: OR MD179056) | |
| 208000000X Pediatrics (Licence: WA MD00043484) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2026-05-28 |