| NPI | 1164536934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 76373) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 76373) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2007-07-08 |