| NPI | 1073883468 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: BOCO C50277) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NC 034220) |
| 224L00000X Pedorthist (Licence: ABC CPED 0855) | |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2015-03-12 |