| NPI | 1134138332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: AZ 1721) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5702) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2025-04-30 |