| NPI | 1992757637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: NC CP001787) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2013-10-01 |