| NPI | 1538295191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: PR 07P1793) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-09 |