| NPI | 1740083799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 125.085610) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL Pending) |
| Enumeration Date | 2025-03-27 |
| Last Update Date | 2025-05-19 |