| NPI | 1992849780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2008-01-16 |