| NPI | 1487075404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125.063608) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 81298) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX W2683) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 14454) | |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2026-05-22 |