| NPI | 1982995973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MN 65160) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 65160) |
| 207R00000X Internal Medicine (Licence: ND 12682) | |
| 208M00000X Hospitalist (Licence: ND 12682) | |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2019-04-16 |