| NPI | 1255685509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 174400000X Specialist |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2019-03-04 |