| NPI | 1174130215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH APRN.CNP.0027506) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027506) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2024-12-03 |