| NPI | 1023240611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: GA ACTIVE) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: MI ACTIVE) |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2009-08-14 |