| NPI | 1386758100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: IA 332bx2000x) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2012-02-16 |