| NPI | 1003667635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 80327) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34261) |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2025-08-20 |