| NPI | 1881667657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 42000) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: MN 42000) |
| 208D00000X General Practice (Licence: MN 42000) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WI 71937) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2020-09-29 |