| NPI | 1205373917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: GA CO102526) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA CO102526) |
| 174400000X Specialist (Licence: GA CO102526) | |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2019-04-03 |