| NPI | 1346204039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35080847) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35080847) |
| 246RM2200X Technician, Pathology, Medical Laboratory | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2021-09-29 |