| NPI | 1902266232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2016-02-29 |