| NPI | 1891967519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301100051) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 57.008283) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2023-10-17 |