| NPI | 1114265485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: ID DME20447) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: ID DME20447) |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2013-01-22 |