| NPI | 1396928123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS10656) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34008893T) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS10656) | |
| Enumeration Date | 2007-12-16 |
| Last Update Date | 2020-11-11 |