| NPI | 1053873950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: OH 34.015940) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: OH 34.015940) |
| 208D00000X General Practice (Licence: OH 34.015940) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-08-25 |