| NPI | 1710481619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 65809) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 29122) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 29814) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2020-08-24 |