| NPI | 1609274653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL ISW8377) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW13356) | |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2020-01-02 |