| NPI | 1396405825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: GA 538132) |
| Enumeration Date | 2021-12-24 |
| Last Update Date | 2022-02-15 |