| NPI | 1184288524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 68195) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 68195) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2022-09-12 |