| NPI | 1972581114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD00046384) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA A85025) |
| 207Q00000X Family Medicine (Licence: CA A85025) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA A85025) | |
| 207Q00000X Family Medicine (Licence: WA MD00046384) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WA MD00046384) | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: WA MD00046384) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2011-03-30 |