| NPI | 1881696177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: OK 21) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: OK 21) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2007-11-20 |