| NPI | 1871842146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: VA T65357821) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: VA T65357821) |
| 332S00000X Hearing Aid Equipment (Licence: VA T65357821) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: VA T65357821) | |
| 335G00000X Medical Foods Supplier (Licence: VA T65357821) | |
| 347C00000X Private Vehicle (Licence: VA T65357821) | |
| 347E00000X Transportation Broker (Licence: VA T65357821) | |
| Enumeration Date | 2012-09-02 |
| Last Update Date | 2012-09-02 |