| NPI | 1235382292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: TX 423450) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2010-07-15 |