| NPI | 1053051078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WI 82864-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 81160) |
| 208M00000X Hospitalist (Licence: MN 81160) | |
| 207Q00000X Family Medicine (Licence: WI 82864-20) | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-11-26 |