| NPI | 1033679527 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0096819)  | 
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DC MTL005316)  | 
| Enumeration Date | 2019-03-21 | 
| Last Update Date | 2023-08-14 |