| NPI | 1619532033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U9531) |
| Additional Taxonomies | 2084N0600X (Licence: IL 036165260) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2025-05-05 |