| NPI | 1235428889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 64526) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 16373) |
| 207Q00000X Family Medicine (Licence: MN 64526) | |
| 207Q00000X Family Medicine (Licence: NV 16373) | |
| 208M00000X Hospitalist (Licence: MN 64526) | |
| 208M00000X Hospitalist (Licence: NV 16373) | |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2025-03-10 |