NPI | 1497711717 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
Enumeration Date | 2006-04-25 |
Last Update Date | 2013-12-19 |