| NPI | 1073944633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X (Licence: CA 5281) |
| Additional Taxonomies | 224900000X Mastectomy Fitter (Licence: CA 2902) |
| 224P00000X Prosthetist (Licence: CA 3476) | |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2016-04-20 |