| NPI | 1497102651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD61301301) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD61301301) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 69772) | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2024-09-05 |