| NPI | 1902148695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 58480) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: MN 58480) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 58480) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2018-11-05 |