| NPI | 1447701701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: NC C84261) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: NC C84261) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2016-10-24 |