| NPI | 1104818335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35071088) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35071088) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2018-05-01 |