| NPI | 1972658987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: NY 176105) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: TN 51770) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2019-11-22 |