| NPI | 1659934669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: MI 2102185764) |
| Additional Taxonomies | 171WH0202X Contractor, Home Modifications (Licence: MI 2102185764) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 2102185764) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MI 2102185764) | |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2020-04-10 |