| NPI | 1568459949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.071595) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A44503) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WV 14147) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35.071595) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-08-22 |