| NPI | 1265404081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: CA 102908) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2008-02-06 |