| NPI | 1295132835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO 460639500) |
| Additional Taxonomies | 207RS0012X Internal Medicine, Sleep Medicine (Licence: MO 460639500) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2014-11-25 |