| NPI | 1699069930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 66860) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: SD 10100) |
| 208M00000X Hospitalist (Licence: ND 13331) | |
| 207R00000X Internal Medicine (Licence: ND 13331) | |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2026-04-24 |