| NPI | 1508309550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: NJ 0075846) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NJ 0075846) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2016-11-23 |