| NPI | 1790102937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 5013 - 12) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2023-11-30 |