| NPI | 1578206470 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 76797) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 76797) | 
| Enumeration Date | 2022-04-18 | 
| Last Update Date | 2025-10-09 |