| NPI | 1376522557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 43081) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 43081) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 43081) | |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2024-08-21 |