| NPI | 1174746465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: DC 15969) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: KY 15969) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: DC 15969) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2008-04-08 |