| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 315D00000X Hospice, Inpatient |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| 251G00000X Hospice Care, Community Based |
| 332BD1200X Durable Medical Equipment & Medical Supplies Dialysis Equipment & Supplies |
| 332BN1400X Durable Medical Equipment & Medical Supplies Nursing Facility Supplies |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition |
| 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2023-08-30 |