| NPI | 1174733968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: 1741) |
| Additional Taxonomies | 111NR0400X (Licence: OH 3363) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2019-02-22 |