| NPI | 1003159005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2020028558) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 007306) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036139810) | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2022-07-21 |