| NPI | 1508326133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 67708) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 29998) |
| 207L00000X Anesthesiology (Licence: MN 67708) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-06-30 |