| NPI | 1215205299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other Electroneurodiagnostic |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2020-01-13 |