| NPI | 1154575165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: NC 1227) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 064966) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2013-05-01 |