| NPI | 1407004948 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 32059)  | 
| Additional Taxonomies | 207YX0901X Otolaryngology, Otology & Neurotology (Licence: AZ 32059)  | 
| Enumeration Date | 2008-09-08 | 
| Last Update Date | 2008-09-08 |