| NPI | 1770502841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00039764) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: WA MD00039764) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2012-02-09 |