| NPI | 1033795596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 79651) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 157871) |
| 207R00000X Internal Medicine (Licence: OH 35.150331) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-07-23 |