| NPI | 1285666917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NC CPO01474) |
| Additional Taxonomies | 174400000X Specialist |
| 1744P3200X Specialist, Prosthetics Case Management | |
| 222Z00000X Orthotist (Licence: NC CPO01474) | |
| 224P00000X Prosthetist (Licence: NC CPO01474) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-08-03 |