| NPI | 1699488007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: OR CO003723) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: WA CO003723) |
| Enumeration Date | 2022-12-30 |
| Last Update Date | 2023-01-13 |