| 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 |