| NPI | 1255444758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: TX 10372) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2018-03-17 |