| NPI | 1700375854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NE 2175) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: IL 90200000X) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2022-11-29 |