| NPI | 1194879775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 2005) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7209350001) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7057360001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7045160001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7939960001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7046960001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7034950001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 8220410001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7629170001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7047150001) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-07-17 |