| NPI | 1205833613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: WA MD00009888) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD00009888) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2017-02-01 |