| NPI | 1184605842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 6657) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7209350001) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7047150001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7045160001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7046960001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7629170001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7034950001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7057360001) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2018-03-20 |