| NPI | 1811770910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 10227) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 70349500001) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7047150001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7209350001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7939960001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 704516001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7046960001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 8220410001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7629170001) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7057360001) | |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-05-21 |