| NPI | 1821468125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 246ZE0500X Specialist/Technologist, Other, EEG | |
| 2472E0500X | |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2015-09-29 |