| NPI | 1063620292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084D0003X Psychiatry & Neurology Diagnostic Neuroimaging (Licence: NY 113240) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: NY 113240) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2007-07-08 |