| NPI | 1225528524 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 171W00000X Contractor |
| 171WH0202X Contractor, Home Modifications | |
| 171WV0202X Contractor, Vehicle Modifications | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2018-07-10 |