| NPI | 1164016978 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CA 228944003) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 228944003) |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: CA 228944003) | |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2021-12-08 |