| NPI | 1326011743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 40536) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 40536) |
| 207Q00000X Family Medicine (Licence: WI 43474) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2011-01-04 |