| NPI | 1366738866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0600X (Licence: TX J1551) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: TX J1551) |
| 2084N0600X (Licence: CA 137089) | |
| 2084N0600X (Licence: TN 50460) | |
| 2084N0600X (Licence: NY 282339) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2022-11-04 |