| NPI | 1861718157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 48505) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57-017658) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IN 01080200A) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY TP529) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35.123794) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2022-08-26 |