| NPI | 1356837868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IL 036.160761) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036.160761) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME147598) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN26212) | |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2022-06-09 |