| 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 |