| NPI | 1497939573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL PED151) |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2008-06-23 |