| NPI | 1598387185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 69505) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R11788) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 69505) | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2024-06-19 |