| NPI | 1154958619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 69507) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 69507) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-06-19 |