| NPI | 1558339101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TN 36815) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 36815) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2008-04-01 |