| NPI | 1073074241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 76924) |
| Additional Taxonomies | 2084N0600X (Licence: MN 76924) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-12-31 |