NPI | 1285663633 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MS 22851) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MS AT0272) |
208VP0000X (Licence: MS 22851) | |
Enumeration Date | 2006-06-30 |
Last Update Date | 2025-06-25 |