| NPI | 1609934819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 33696) |
| Additional Taxonomies | 2084H0002X (Licence: NC 33696) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NC 33696) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2011-10-04 |