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 |