| NPI | 1083136535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MN 69633) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30733) |
| Enumeration Date | 2017-07-15 |
| Last Update Date | 2021-08-30 |