| NPI | 1790171403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 72984) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD467185) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2023-07-06 |