NPI | 1609937572 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: IL 213-000230) |
Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: IL 211-000188) |
335E00000X Prosthetic/Orthotic Supplier (Licence: IL 212-000130) | |
Enumeration Date | 2006-12-13 |
Last Update Date | 2008-01-16 |