| NPI | 1104105089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: CO 1009261) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: CO 1009261) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2011-08-29 |