| NPI | 1033111968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 7023) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC 20733) |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: NC 20733) | |
| 211D00000X Assistant, Podiatric (Licence: NC 20733) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2009-03-12 |