| NPI | 1376547711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 29908) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 29908) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2011000734) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2013-02-18 |