| NPI | 1376801258 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 1591) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TX 1591) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2025-01-10 |