| NPI | 1790166569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 75722) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125067290) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2023-11-28 |