| NPI | 1144777137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other Electroneurodiagnostic |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2019-09-04 |