| NPI | 1942290275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00020220) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 22349) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD00020220) | |
| 208M00000X Hospitalist (Licence: WA MD00020220) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2019-07-22 |