| NPI | 1184177727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 171WV0202X Contractor, Vehicle Modifications |
| 171WH0202X Contractor, Home Modifications | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 246YR1600X Spec/Tech, Health Info, Registered Record Administrator | |
| 146D00000X Personal Emergency Response Attendant | |
| 261QE0002X Clinic/Center, Emergency Care | |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2016-08-16 |