| NPI | 1134864119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 22972) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 22972) |
| 207R00000X Internal Medicine (Licence: MI 4351050202) | |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2025-09-26 |