| NPI | 1285081927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: NJ 3394NJ) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 3394NJ) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2016-05-23 |