| NPI | 1447776760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 83192) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 35283) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2026-07-14 |