| NPI | 1598239345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0500X Specialist/Technologist, Other, EEG (Licence: TX 514) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
| 2472E0500X (Licence: TX 3654) | |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2019-05-08 |