| 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 |