| NPI | 1093259236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH WILLIAM LICAUSI Owner 702-637-0008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NV 2000418-345) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NV 2001216-346) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2016-12-07 |