| NPI | 1902198096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WA MD60460446) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60460446) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2015-05-12 |