| NPI | 1063894293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 62769) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN21205) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2018-09-04 |