| NPI | 1225263163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60266371) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207X00000X Orthopaedic Surgery (Licence: WA OP60266371) | |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2015-02-18 |