| NPI | 1730179870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 30422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 30422) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2015-10-30 |