| NPI | 1942456918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125053591) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125053591) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 309938) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2023-07-07 |