| NPI | 1588953293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2014-05-12 |