| NPI | 1710912498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 5101009950) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MI 5101009950) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WV 2077) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: OH 34.016792) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2025-08-19 |