| NPI | 1104248715 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 31518) |
| 224900000X Mastectomy Fitter (Licence: CA C70689) | |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2024-09-23 |