| NPI | 1548617525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 246X00000X Spec/Tech, Cardiovascular |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2019-06-26 |