| NPI | 1831560895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies |
| Additional Taxonomies | 332BD1200X Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2015-10-15 |