| NPI | 1932630266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WA MD61061077) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61061077) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2020-09-21 |