| NPI | 1083037873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CA 865640) |
| Additional Taxonomies | 171W00000X Contractor (Licence: CA 865640) |
| 171WH0202X Contractor, Home Modifications (Licence: CA 865640) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 865640) | |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2014-01-31 |