| NPI | 1780625509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2013-01786) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 160284) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: NC 2013-01786) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 2013-01786) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2021-10-08 |