| NPI | 1720693104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: 1075) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: 5742) |
| 246Z00000X Specialist/Technologist, Other (Licence: 5944) | |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2022-11-18 |