| NPI | 1518169713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 49521) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MN 49521) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 49521) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2019-08-15 |