| NPI | 1336234517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: 1687) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002019A) |
| 111N00000X Chiropractor (Licence: KY 5020) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2013-08-13 |