| NPI | 1558532135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 20158) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 20158) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2008-04-08 |