| NPI | 1629519681 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224L00000X (Licence: KY 111358) |
| Additional Taxonomies | 224900000X Mastectomy Fitter (Licence: KY CFm03052) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2017-03-10 |