| NPI | 1174516579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX S3612) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IL 036098951) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2019-11-04 |