| NPI | 1740677699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35.136795) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.136795) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2023-07-18 |