| NPI | 1104203397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 65564) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: OH 35133683) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2019-06-03 |