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 |