| NPI | 1659347227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: CO 06903) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CO 06903) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2015-05-04 |