| NPI | 1659661650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036-140319) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: IL 036140319) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2021-04-26 |