| NPI | 1659364396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036168702) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T6429) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61530096) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 17900) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 4023) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2024-12-16 |