| NPI | 1609211606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 58153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 58153) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2019-02-07 |