| NPI | 1467010330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 78121) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-12313) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2025-03-12 |