| NPI | 1962654731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OH 35052257) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35052257) |
| 209800000X Legal Medicine (Licence: OH 35052257) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35052257) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: OH 35052257) | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2011-02-25 |