| NPI | 1578684817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: DC mc10997) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD 10997) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |