| NPI | 1023451101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: MN 59778) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MN 59778) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 59778) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 59778) | |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2023-06-30 |