| NPI | 1184124315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Additional Taxonomies | 247200000X (Licence: WA 2931) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2018-02-14 |