| NPI | 1497041438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 53282) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: CA 53282) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2012-01-05 |