| NPI | 1669676755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: AL 208488225) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: AL 208488225) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2007-12-17 |