| NPI | 1689519829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: GA BR018475) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: GA BR018475) |
| 174400000X Specialist (Licence: GA BR018475) | |
| Enumeration Date | 2026-04-22 |
| Last Update Date | 2026-04-29 |