| NPI | 1851632087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: UT 12611471-004-stc) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2013-03-13 |