NPI | 1124466222 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 58143) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 58143) |
208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MN 58143) | |
Enumeration Date | 2013-06-11 |
Last Update Date | 2022-11-08 |