| NPI | 1912400714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125.081976) |
| Additional Taxonomies | 174H00000X Health Educator |
| 247000000X Technician, Health Information | |
| Enumeration Date | 2018-03-18 |
| Last Update Date | 2023-05-16 |