| NPI | 1639456122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X (Licence: IL 036-131386) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 263489) |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2017-08-23 |