| NPI | 1245953603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: NJ 32WD02927600) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NJ 32WD02927600) |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2022-09-21 |