| NPI | 1043907413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDI NICHOLE WALLACE Hair Loss Practitioner 667-281-9603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-11-16 |