| NPI | 1801139795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 58859) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MN 58859) |
| 208M00000X Hospitalist (Licence: WI 65475-20) | |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2016-08-30 |