| NPI | 1841603685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WA MD61052672) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61052672) |
| 208000000X Pediatrics (Licence: WA MD61052672) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2020-08-05 |