| NPI | 1508682071 |
|---|---|
| Professional Name | NA NA NA |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: OH 335E00000X) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: OH 29byidrxdq) | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2024-11-29 |
| Last Update Date | 2024-11-29 |