| NPI | 1336470616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN P TYMCHAK Director 812-858-1005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IN 08002011A) |
| Additional Taxonomies | 208D00000X General Practice |
| 133NN1002X Nutritionist, Nutrition, Education (Licence: IN 08002011A) | |
| Enumeration Date | 2010-01-26 |
| Last Update Date | 2012-08-30 |