| NPI | 1881933117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171WH0202X Contractor, Home Modifications (Licence: WA SAFEAA 880QW) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2013-02-06 |