| NPI | 1134154099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA03940800) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 110730-1) |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: 1156) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2014-05-14 |