| NPI | 1821224767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35.120966) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.120966) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2022-02-23 |