| NPI | 1780173575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61116477) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WA MD61116477) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2021-08-31 |