| NPI | 1962031914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 69580) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30726) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2021-07-23 |