| NPI | 1376983346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-141124) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301114315) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125.064175) | |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2018-06-05 |