| NPI | 1982197067 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 78941) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 75124-20) | 
| 207R00000X Internal Medicine (Licence: NV 24770) | |
| 208M00000X Hospitalist (Licence: WI 75124-20) | |
| Enumeration Date | 2018-06-13 | 
| Last Update Date | 2025-07-31 |