NPI | 1568477354 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: WA OP60081051) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WA OP60081051) |
Enumeration Date | 2006-07-30 |
Last Update Date | 2022-12-19 |