| NPI | 1063441236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: WA MD00017432) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: WA MD00017432) |
| 207QS0010X Family Medicine Sports Medicine (Licence: WA MD00017432) | |
| 2080S0010X Pediatrics Sports Medicine (Licence: WA MD00017432) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: WA MD00017432) | |
| 2083S0010X Preventive Medicine Sports Medicine (Licence: WA MD00017432) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2007-07-08 |