| NPI | 1811559628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X (Licence: AZ 80223) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 036.165188) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301517127) | |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2026-04-17 |