| NPI | 1083058721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY EMMANUEL BASKIN Owner/ Practitioner 703-209-3790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: VA CP03073) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2021-03-03 |