| NPI | 1356879654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 64068) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 64068) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 28954) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 64068) | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-07-21 |