| NPI | 1598792657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60992612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-27421) |
| 208000000X Pediatrics (Licence: KS 0427421) | |
| 208000000X Pediatrics (Licence: WA MD60992612) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2019-12-17 |