| NPI | 1063440311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 039773) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: MI 039773) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2011-08-11 |