| NPI | 1235126525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 28531) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME60559) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: FL ME60559) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 28531) | |
| Enumeration Date | 2005-10-01 |
| Last Update Date | 2020-08-04 |