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 |