| NPI | 1205066149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: NJ 1436) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2015-09-16 |