| NPI | 1790893683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 37590) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35-082552) |
| 207L00000X Anesthesiology (Licence: KY 37590) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35-082552) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 37590) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2018-10-16 |