| NPI | 1003544073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: SC 056515) |
| Additional Taxonomies | 251E00000X Home Health |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2022-08-30 |