| NPI | 1063476216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 31154) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: KY 31154) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 31154) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.092370) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-02-07 |