| NPI | 1154622348 |
|---|---|
| Former Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WA 603 054 754) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2010-11-09 |