| NPI | 1053514984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Additional Taxonomies | 231H00000X Audiologist (Licence: CO 290) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2013-04-24 |