| NPI | 1811411283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 332BD1200X Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2018-06-16 |