| NPI | 1093025801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 57939) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MO 2012010370) |
| 207R00000X Internal Medicine (Licence: MN 57939) | |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2015-10-30 |