NPI | 1720010234 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: CA A46373) |
Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A46373) |
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A46373) | |
Enumeration Date | 2006-07-07 |
Last Update Date | 2009-05-29 |