| NPI | 1548420318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WA 60279382) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 65744) |
| 208000000X Pediatrics (Licence: WA MD 60279382) | |
| Enumeration Date | 2008-06-14 |
| Last Update Date | 2018-05-22 |