| NPI | 1861758773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 60625) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 60625) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2016-07-11 |