| NPI | 1962602433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: 1295) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 1295) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2013-04-29 |