| NPI | 1609187467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036.150494) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN15464) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME 120484) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 269192) | |
| Enumeration Date | 2010-06-27 |
| Last Update Date | 2019-08-19 |