| NPI | 1447517115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 58883) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: MN 58883) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2019-03-26 |