| NPI | 1063698645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX N2492) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57-011358) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2024-01-16 |