| NPI | 1609496066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 036.164418) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125075488) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.075488) | |
| Enumeration Date | 2020-04-25 |
| Last Update Date | 2024-06-12 |