NPI | 1902263700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: UT 12256626-1714) |
Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
Enumeration Date | 2016-01-25 |
Last Update Date | 2022-01-25 |