| NPI | 1083057970 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 61933) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 285077) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2019-06-11 |