| NPI | 1831456953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MN 62413) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 62413) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2022-07-21 |