| NPI | 1659458842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WA OP60308517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4506) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-05-30 |