| NPI | 1982197067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 78941) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WI 75124-20) |
| 208M00000X Hospitalist (Licence: IL 036176768) | |
| 207R00000X Internal Medicine (Licence: NV 24770) | |
| 207R00000X Internal Medicine (Licence: WI 75124-20) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2025-12-22 |