| NPI | 1184071896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: IL 036152212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101022846) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2022-02-10 |