| NPI | 1548059785 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085011366) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085011366) |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: IL 085.011366) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 085011366) | |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-11-18 |