| NPI | 1235575879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MN 59773) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 59773) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 59773) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2020-08-04 |