| NPI | 1356602429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 76960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9360) |
| 207Q00000X Family Medicine (Licence: VA 0101258135) | |
| 208M00000X Hospitalist (Licence: VA 0101258135) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2025-06-03 |