| NPI | 1740329259 |
|---|---|
| Other Name | IDA RAE PROCTOR |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MS B1208544) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-07-08 |