| NPI | 1336103951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 24703) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 24703) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2020-11-10 |