| NPI | 1972709129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60563130) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 50935) |
| 208000000X Pediatrics (Licence: WA MD60563130) | |
| 208000000X Pediatrics (Licence: WI 50935) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2021-05-18 |