| NPI | 1720085459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35092154) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.092154) |
| 207L00000X Anesthesiology (Licence: KY 34587) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 34587) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35-092154) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2017-03-08 |