| NPI | 1396919791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60374418) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60374418) |
| 207X00000X Orthopaedic Surgery (Licence: CA A108954) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2014-08-18 |