| NPI | 1881250926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-47836) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 77982) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA MD-47836) | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2025-01-29 |