| NPI | 1912985094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35062677) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35062677W) |
| 208VP0000X (Licence: OH 35062677) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2012-12-18 |