| NPI | 1750621801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: 2344) |
| Additional Taxonomies | 2472E0500X (Licence: TX 2344) |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2022-07-21 |