| 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 | 2025-09-23 |