| NPI | 1508204637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 58152) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MN 58152) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2018-05-21 |