| NPI | 1750044392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X (Licence: C50032) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: C50032) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2024-11-20 |