| NPI | 1457864027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WAVRA Member 307-201-2610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2018-08-28 |