| NPI | 1225149883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 43013) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 43013) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 43013) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-04 |