| NPI | 1639165145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 67244) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 67244) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OH 67244) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2014-12-03 |