| NPI | 1407918931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA 6000004426) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: PA 6000004426) |
| 332BD1200X Durable Medical Equipment & Medical Supplies Dialysis Equipment & Supplies (Licence: PA 6000004426) | |
| 332BN1400X Durable Medical Equipment & Medical Supplies Nursing Facility Supplies (Licence: PA 6000004426) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: PA 6000004426) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies (Licence: PA 6000004426) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: PA 6000004426) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-09 |