| NPI | 1316135585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35090518) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35090518) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.090518) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2015-12-18 |