| NPI | 1235419227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: VA ATP 5188) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2023-04-14 |