| NPI | 1639134943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00036767) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00036767) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-05-07 |