| NPI | 1720248636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 69146) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125-054708) |
| 208000000X Pediatrics (Licence: WI 57159-20) | |
| 207R00000X Internal Medicine (Licence: IL 125-054708) | |
| 207R00000X Internal Medicine (Licence: WI 57159-20) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2021-05-25 |