| NPI | 1477506251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME154017) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35064726) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2022-05-18 |