| NPI | 1558561282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61088400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 2329900) |
| 208000000X Pediatrics (Licence: WA MD61088400) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2020-10-09 |