| NPI | 1700672961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IL 043134090) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2025-04-15 |