| NPI | 1487206298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171WH0202X Contractor, Home Modifications |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2026-01-07 |