| NPI | 1396706156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NC 17069) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: NC 17069) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2007-07-08 |