| NPI | 1053622308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 54271) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MN 54271) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2020-11-09 |