| NPI | 1972820231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 38313) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 38313) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2010-04-27 |