| NPI | 1568826816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 62757) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 62757) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2022-07-21 |