| NPI | 1639739709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 96376) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OS022285) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-07-27 |