| NPI | 1114005683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 171W00000X Contractor (Licence: CT 06-1357833) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-04-04 |