| NPI | 1659377281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NV 2439) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: NV MP00099) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2018-09-18 |