| NPI | 1376779298 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171WH0202X Contractor, Home Modifications |
| Additional Taxonomies | 171W00000X Contractor |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2009-06-05 |