| NPI | 1063085629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 171W00000X Contractor |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2021-07-21 |