| NPI | 1720297591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-128592) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-7769) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-7769) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036-128592) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2015-02-10 |