| NPI | 1659514909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD60298925) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60096913) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2021-10-15 |