| NPI | 1770478786 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2025-06-10 |
| Last Update Date | 2025-06-10 |