| NPI | 1609860048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: TX 445) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 445) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2009-04-28 |