| NPI | 1407897994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 11379) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PR 11379) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-06-16 |