| NPI | 1326069725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OH 35045205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35045205) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35045205) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-08 |