| NPI | 1164572319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: IL 036040753) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 036040753) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2010-03-30 |