| NPI | 1588028161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: MN 63069) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN 63069) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN 27574) | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2020-08-05 |