| NPI | 1578912572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X (Licence: IL 036158535) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY TP227) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 32256) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2025-06-30 |