| NPI | 1972742120 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: IL 4505) | 
| Additional Taxonomies | 246ZE0500X Specialist/Technologist, Other, EEG (Licence: IL 4505) | 
| Enumeration Date | 2009-02-11 | 
| Last Update Date | 2018-09-12 |