| NPI | 1255301743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 46656) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 46656) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2020-06-24 |