| NPI | 1770570186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35086212) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD425120) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WV 21925) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2024-08-13 |