| NPI | 1538740402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72820) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MN 72820) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2026-02-24 |