| NPI | 1275587727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: IL 036.147372) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 10564) |
| 207Q00000X Family Medicine (Licence: SD 1119) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2018-09-21 |