| NPI | 1326310376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 1000228) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2013-08-28 |