| NPI | 1366246126 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 125.086329) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.086329) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2025-06-23 |