| NPI | 1275274292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL CL1189139) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL CL1189139) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: FL CL1189139) | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-04-05 |