| NPI | 1003681701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL RUDOLPH Owner 502-539-9872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 347C00000X Private Vehicle |
| Enumeration Date | 2023-11-22 |
| Last Update Date | 2023-11-22 |