| NPI | 1275237091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125081776) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 390200000x) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2023-09-25 |