| NPI | 1154701282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 64494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL38233) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2018-08-23 |