| NPI | 1922040898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other Electroneurodiagnostic (Licence: 561) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: FL 57895) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-07-08 |