| NPI | 1164831053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GYASI JACKSON President 347-854-9137 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2021-11-05 |