| NPI | 1083033450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: TX 1490) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 191423) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2019-09-04 |