| NPI | 1568447399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101252730) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101252730) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MD D0055111) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2021-03-10 |