| NPI | 1881794410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: AL 22682 PERMIT 900543) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 440) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2007-11-20 |