| NPI | 1710982400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00018272) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00018272) |
| 208M00000X Hospitalist (Licence: WA MD00018272) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2010-11-30 |