| NPI | 1851682629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MN 60375) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 60375) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2018-09-07 |