| NPI | 1609447713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BD1200X Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies (Licence: TX 1712206) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2021-07-08 |