| NPI | 1154945608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 77254) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10072171) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2024-06-25 |