| NPI | 1821230574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 54967) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 54967) |
| 208000000X Pediatrics (Licence: MN 54967) | |
| Enumeration Date | 2009-03-26 |
| Last Update Date | 2023-08-11 |