| NPI | 1578608782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 53084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC061105) |
| 207R00000X Internal Medicine (Licence: MN 20349) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2019-02-28 |