| NPI | 1194385286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68095) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MO 2023013387) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2026-01-19 |