| NPI | 1568931707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 172A00000X Driver |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| 332BD1200X Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies | |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies | |
| 347C00000X Private Vehicle | |
| 347E00000X Transportation Broker | |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2018-11-16 |