| NPI | 1275277600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2022-06-21 |