| NPI | 1942569843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L. KOSTREVA Dir. Of Operatons Mid West. 331-330-3336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: IL 246ZE0600X) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2012-05-11 |