NPI | 1902958028 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 34005660) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34005660) |
207Q00000X Family Medicine (Licence: KY 02723) | |
Enumeration Date | 2007-01-17 |
Last Update Date | 2012-12-13 |