| NPI | 1558466763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 100982) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 18120) |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: DE CF002312) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2019-02-05 |