| NPI | 1790571271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1744P3200X Specialist Prosthetics Case Management |
| Enumeration Date | 2025-04-19 |
| Last Update Date | 2025-04-19 |