| NPI | 1942566690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35129402) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.129402) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2018-10-26 |