| NPI | 1639131592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CPO1835) |
| 224P00000X Prosthetist (Licence: CPO1835) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2013-09-30 |