| NPI | 1821301698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 75720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301097426) |
| 207Q00000X Family Medicine (Licence: OH 35129717) | |
| 208M00000X Hospitalist (Licence: MI 4301097426) | |
| 207Q00000X Family Medicine (Licence: WI 3759-320) | |
| 208M00000X Hospitalist (Licence: OH 35129717) | |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2025-10-09 |