| NPI | 1528588795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH WEATHERWAX Director 469-646-8663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 293D00000X Physiological Laboratory |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine |
| 246ZE0500X Specialist/Technologist, Other, EEG | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-06-21 |