| NPI | 1740452812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 51767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 51767) |
| 208D00000X General Practice (Licence: IN 11012848A) | |
| Enumeration Date | 2008-03-29 |
| Last Update Date | 2020-12-04 |