| NPI | 1417670035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: NJ 40QB00390100) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NJ 40QB00390100) | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2022-09-20 |