| NPI | 1720423643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MN 58337) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 58337) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 58337) | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2018-06-13 |