| NPI | 1184723553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35074125N) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 33854) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: KY 33854) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: OH 35-074125) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2011-06-17 |