| NPI | 1508182239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204R00000X Electrodiagnostic Medicine (Licence: CA A119964) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2024-05-22 |