| NPI | 1285041640 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 61932) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 19962) | 
| Enumeration Date | 2014-07-17 | 
| Last Update Date | 2020-10-06 |