| NPI | 1073607909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35090663) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35090663) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2013-06-29 |