| NPI | 1912033663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: WA MD00023987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00023987) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WA MD00023987) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2025-08-08 |