| NPI | 1285153593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WAVRA Partner 307-201-2610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 293D00000X Physiological Laboratory |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| 2472E0500X | |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2018-03-22 |