| NPI | 1487768552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IN 01066275A) |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: IL XO9045027) |
| 146D00000X Personal Emergency Response Attendant (Licence: IL 036092087) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2020-03-09 |