| NPI | 1881042174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 62502) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 62502) |
| 207R00000X Internal Medicine (Licence: PA MT211512) | |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2020-08-05 |