| NPI | 1780244244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: IL 036.157693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.075004) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-10-15 |