| NPI | 1538455977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA OP60967755) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: WA OP60967755) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WI 81396) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 81396) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2024-02-21 |