| NPI | 1053608927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2011-06-30 |