| NPI | 1639151079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35.123682) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.123682) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.123682) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35.123682) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35.123682) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2018-11-28 |