| NPI | 1912056078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WA MD00044735) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00044735) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2018-09-18 |