| NPI | 1366245706 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 83215) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 35277) |
| Enumeration Date | 2025-03-31 |
| Last Update Date | 2026-07-27 |