| NPI | 1255784013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: MI L777466) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI L777466) |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: MI L777466) | |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |