| NPI | 1578727095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies (Licence: TX 0029692) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 0013033) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2008-11-02 |