| NPI | 1598038945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NV mp00225) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: NV mp00225) |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2012-02-15 |