| NPI | 1114508256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 82523) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.078128) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 125078128) | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2026-08-13 |