| NPI | 1295056570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 8959) |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other Electroneurodiagnostic |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2022-07-21 |