| NPI | 1699303909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 69545) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 69545) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 30761) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-07-01 |