| NPI | 1912324559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60300185) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60300185) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2023-10-15 |