| NPI | 1497416598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: MO 2010014757) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 2010014757) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MO 2010014757) | |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: MO 2010014757) | |
| Enumeration Date | 2022-01-01 |
| Last Update Date | 2022-01-01 |