| NPI | 1649825290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: DC MTL005789) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DC MD210012194) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2023-08-28 |