| NPI | 1912583576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 80567) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME167950) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-11-17 |