| NPI | 1275507386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 36456) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 36456) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 36456) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2021-03-11 |