| NPI | 1770861197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 57421) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MN 57421) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2021-09-03 |