| NPI | 1083108898 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 99310)  | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036156241)  | 
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125.072984)  | |
| Enumeration Date | 2018-06-15 | 
| Last Update Date | 2025-07-18 |