| NPI | 1578096376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other (Licence: OK #86759) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2017-04-19 |