| 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 |