| NPI | 1639551849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: TN PRO0000000023) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: TN ORT0000000023) |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: TN PRO0000000023) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: TN ORT0000000023) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2015-06-24 |