| NPI | 1548543861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2020-12-22 |