| NPI | 1700863412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X (Licence: OH 36-00-3099-K) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OH 36003099) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2008-07-03 |