| NPI | 1114985520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35.120658) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.120658) |
| 207L00000X Anesthesiology (Licence: NY 271685) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 271685) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD423112) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2025-07-02 |