| NPI | 1548044050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2023-08-25 |