| NPI | 1750959649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: FL 1320048518) |
| Additional Taxonomies | 251F00000X Home Infusion (Licence: FL 1320048518) |
| 3336M0002X Pharmacy, Mail Order Pharmacy | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2022-03-23 |