| NPI | 1962881318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036165554) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01078057A) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: IL 036165554) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 11018125A) | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2024-05-30 |