| NPI | 1366141798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BD1200X Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies | |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: GA 1366141798) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2023-03-14 |