| NPI | 1558106096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 80268) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34318) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2025-08-01 |