| NPI | 1386676369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 21006543) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2017-05-27 |