| NPI | 1508362757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: VA 0206010050) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2019-04-11 |