| NPI | 1477545804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34004565) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 34004565) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2010-01-15 |