| NPI | 1740856897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 57.257781) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4351048639) |
| Enumeration Date | 2021-05-31 |
| Last Update Date | 2026-08-04 |