| NPI | 1093986531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 222Z00000X Orthotist |
| 174400000X Specialist | |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2016-06-28 |