| NPI | 1336219781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: TX 0073430) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2022-05-31 |