| NPI | 1144969114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WOLFF Single Member LLC 712-899-6167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| Enumeration Date | 2022-05-29 |
| Last Update Date | 2022-05-29 |