| NPI | 1851409098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 32916) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MN 32916) |
| 208M00000X Hospitalist (Licence: CA G68677) | |
| 207R00000X Internal Medicine (Licence: MN 32916) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2019-09-05 |